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Presentation Standards The Taming of the Queue: National Invitational Colloquium on Wait Time Measurement, Monitoring and Management Wait List Management of Diabetes in Capital Health Capital Health Edmonton, Alberta Presenter: Marianne Stewart, Senior Operating Officer, Primary Care Division, Capital Health Co Authors: Dr. Richard Lewanczuk Kathleen Ness Michele Lahey Angela Estey Outline z Capital Health z Alberta’s Approach to Queues z Wait List Management of Diabetes in Capital Health z Drivers of Change z Vision and Model for Diabetes Services z Outcomes z Next Steps: Rolling Out the Diabetes Virtual Team z Future Direction for Chronic Disease Management April 1, 2004 3 Capital Health Overview Capital Health Re Sturgeon • Region County Fort • • Saskat St Albert • Strathcon • • County • Yellowhead Sto•ny • • ounty (East) Parkland County Plain Edmont•on Devon • • Leduc Leduc County April 1, 2004 4 Capital Health Overview cont’d Academic Health Region: z Pop. - 1 m (referral base 1.6 m) z $2.2 billion budget z 20,000 staff z Northern Alberta’s largest employer z 2,300 physicians z Full range of health faculties: z 520 medical residents/fellows z 6,000+ students April 1, 2004 5 Capital Health Overview cont’d z 13 hospitals z 2,600 acute care beds* z 110,000 separations annually z 450,000 emergency visits annually z Community Care Services z 5,700 continuing care beds/spaces z 22 public health centres / 4 clinics z Community Mental Health Services z Capital Health Link (10,000 calls/wk) * includes psychiatric and adult & pediatric ICU beds April 1, 2004 6 The Provincial Approach zAlberta Waitlist Registry z Online registry for insured surgeries/procedures zBooking Services z Centralized system to book select services z Begin with orthopedics followed by primary health care services via Health Link Alberta April 1, 2004 7 The Provincial Approach cont’d z Access Standards z To establish acceptable wait time standards for selected services: » MRI/CT scans » Major joint replacement » Breast and prostate cancer » Cardiac » Children’s Mental Health April 1, 2004 8 Wait List Management of Diabetes in Capital Health April 1, 2004 9 The Problem z Limited number of physician specialists z Limited health care resources z Obesity epidemic (ballooning incidence) z Aging population Our current approach to the treatment of diabetes was unsustainable April 1, 2004 10 The Problem: Access to Treatment Delivery Approach Resulting Problem z Multiple non-standardized z Long wait times for service models service/treatment (4-8 months) z Multiple entry points z 1000 waiting for z Inconsistent definitions service/treatment and collection of wait time data z Limited access - small percent of total diabetes z No regional coordinated population being seen in strategy for wait times diabetes centres z No standards for wait z Reached 20% of diabetic times population April 1, 2004 11 Old System for Diabetes Services known undiagnosed excellent care Problems Only small proportion of diabetes population served seen not seen Increase Capacity of Old System known undiagnosed Increasing resources has only marginal impact seen not seen 2X capacity 3X capacity Tripling Capacity In the Capital Health Region Means: Current resources: Tripling capacity: z 22 diabetes specialists z 66 diabetes specialists z 11.1 nurses z 33.3 nurses z 8.15 dietitians z 24.45 dietitians 24.45 diabetes Plus: triple space, triple parking, triplespecialists clerical resources, etc 33.3 nurses April 1, 2004 24.45 dieticians 14 Our Goal known undiagnosed Excellent Care Re-engineering to increase capacity seen not seen What We Did A New Model for Diabetes First Steps z Establishing physician leadership and involvement z Conducted a Visioning Session: z Attended by key stakeholders z Guiding principles developed z Led to development of operational model April 1, 2004 16 Regional Solution: A New Model for Diabetes Care Principles z Use best practice in diabetes management z Build on recommendations of accreditation team z Use integrated approach z Include ongoing stakeholder input z Develop a responsive monitoring system to drive decision making z Incremental, planned approach to service change April 1, 2004 17 INTEGRATED DIABETES SERVICES DELIVERY MODEL FOR CAPITAL HEALTH POPULATION PRIMARILY INTEGRATED SERVICE DELIVERY SYSTEM MAJOR SERVED PRESENT AT: FUNCTIONS Newly Diagnosed Ë Primary Care SUPPORTING P hysi c ian s PRIMAR Y S.D . MECHANI SMS Ë Type 1 VEHICLES Ë Type 2 Sp ecialists Cas e Find Ë GDM Amb ul atory Cl in ic s Ë Diabetes Centres Education Primary Care Acute Inpatient Care Diagnosed Physicians Long-Term Care Follow-Up Ë Opt imal Ë Emergency Room Commu nity Care Ë Home Care Patient/Family Ë Public Health Treatment Ë Acute Care Canadian Diabetes I npatient As sociation Ë Su boptimal Alberta Health & Ë Sp ecialist Wellness Diabetes Centres Healthlink Ë In adequate Pharmacies Ë Diabetes Screening Clinics Regional Service Coordination Infrastructure Monitoring & Ë Commu nity Ë A dmi ni str ation Ë Human Resources Surveillance High Risk Health Services Ë In formati on Syste ms Ë Funding Structures Population/ Ë Policy and Procedures Ë Epidemiologic Not Diagnosed Ë Research Integration Ë Trends & Data Ë Pharmacy R ESEAR CH AN D QU ALITY IM P RO VEM ENT AprilË 1, E v2004idence-based Practices Ë Treatment Standards and Protocols Ë Benchmarks Ë Outcomes/Results18 Regional Solution: A New Model for Diabetes Care Wait Time Strategies: z Single point of entry through Capital Health Link z Standardized referral process z Evidence-based triage criteria for new referrals; developed by clinicians to ensure right provider, right time, right place z Triage team to ensure integrity/adherence of process (at Capital Health Link) z Regular monitoring of waitlist - diversion of referrals and waitlist balancing April 1, 2004 19 Chronic Disease Service Delivery Strategy of Progression of Care Specialty Clinics Specialty care with diabetologist and multi-disciplinary teams Triage: Right Service Single Point of Right Provider Diabetes Centre Case Find Access Team intervention (Capital Health Link) individualized care with multi-disciplinary teams and MD support as required Community Based Programs Group education, telephone follow-up by RN/RD Continuous Monitoring of Patient Outcomes April 1, 2004 20 Outcomes z Reduced wait times z Wait times dropped from 4-8 months across the region to 2 weeks z Increased access z From 20% of diabetes population to projected 35% of entire diabetes population in first year z Tracking costs April 1, 2004 21 Outcomes cont’d CAPITAL HEALTH Total Number of Referrals by Month July 9, 2003 - February 29, 2004 1000 900 800 717 697 s al 700 634 r r 593 e f 600 539 e 532 534 484 R f 500 o er 400 b m u 300 N 200 100 0 Pre July Aug Sept Oct Nov Dec Jan Feb Change Months April 1, 2004 22 Outcomes cont’d zIncreased capacity: z Redirected physician specialists time to focus more on specialty clinics z Redirected staff time to provide more comprehensive follow-up of all patients z Established a community based diabetes team from existing resources April 1, 2004 23 Outcomes cont’d z Process z Single point of entry - easier access for primary care physicians and patients z Standardized processes z Evidence based decision making z Standardized, timely data April 1, 2004 24 Outcomes cont’d From the physician perspective: z Physicians report “they are reassured” patients are now prioritized and seen in timely manner z More time to do diagnosis and treatment plans z Nurses managing the follow-up z Referring physician commented she was “thrilled” with only one number to call” April 1, 2004 25 Outcomes cont’d From the physician perspective: z Appreciate the value of process re-engineering rather than adding resources to an existing system z “Late adopters” are now suggesting new innovations in diabetes health delivery z Physicians frequently comment that they would not return to the old system April 1, 2004 26 What We Have Learned z Plan and monitor change management strategies from the beginning z Extensive stakeholder involvement is essential when designing waitlist management strategies z Need strong physician champion April 1, 2004 27 What We Have Learned cont’d z Need process to deal with existing patients when shifting to new system z Centralized referral/booking system allowed re- distribution of waitlists between sites and decreased wait times z Waitlist required - most patients need a few weeks notice for appointment z Principles to guide decisions are important April 1, 2004 28 Next Steps: Rolling Out the Diabetes Virtual Team What is the Virtual Team? z Primary care physicians and providers will have access to a virtual team of diabetes specialists z Team includes Physician Specialist, Registered Nurse, Dietitian » With access to pharmacy and social services z For health regions in central and northern Alberta z Launching summer 2004 April 1, 2004 29 Next Steps: Rolling Out the Diabetes Virtual Team cont’d z Functions of the Virtual Team z Will provide direction, consultation, and promotion of evidence-based clinical management z Direct care - registered Type 2 diabetes patients z Roles of the Team z Physicians - diagnose and create treatment plans z Other team members: » follow-up and monitor required action between physician visits » refer to other services and programs » refer back to physician if further assessment required April 1, 2004 30 Next Steps: Rolling Out the Diabetes Virtual Team cont’d z Enabling the Team: z Electronic Health Record - access to lab data, discharge summaries, event histories,
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